An Interactive Computer-Animated System (SpiroGame) Facilitates Spirometry in Preschool Children

Abstract

Although airway disease in preschool children is common, standard spirometry is limited by the level of cooperation. We evaluated a computer-animated system (SpiroGame) aimed at improving children's performance in spirometry. SpiroGame includes a commercial pneumotachograph (ZAN100; ZAN Messgeraete GmbH, Oberthulba, Germany) and games teaching tidal breathing and all steps of an FVC maneuver. SpiroGame was compared with commercial flow-targeted candle-blowing software (MasterLab, Jaeger, Germany), and with extrapolated predicted values. Of 112 children aged 3 to 6 yr, 10 refused spirometry and 102 proceeded to FVC games and were randomized to initially perform either SpiroGame or candle-blowing. Training lasted 5 to 10 min for SpiroGame and 3 to 7 min for candle-blowing. Acceptable spirometry was performed by 69 of 102 children with SpiroGame and 48 of 102 with candle-blowing (p = 0.005). Order did not affect success. Acceptable FEV(1) maneuvers were achieved by 55 children with SpiroGame and two children with candle-blowing. The intrasubject coefficient of variation was 4.0% for FVC and 3.3% for FEV(1) with SpiroGame. A premature expiratory break occurred in 41 subjects with candle-blowing and in six with SpiroGame. FEV(0.5) could be measured with both systems. FVC and maximal midexpiratory flow at 50% of FVC (MMEF(50)) values were similar, whereas peak expiratory flow was higher with candle-blowing. In 39 healthy children, most parameters with SpiroGame were similar to extrapolated normal values. We conclude that an interactive computer-animated system facilitates successful spirometry in preschool children.

Efeito da terminação precoce da expiração nos parâmetros espirométricos em crianças pré-escolares saudáveis

“…In terms of variability, there were no Early termination of exhalation: effect on spirometric parameters in healthy preschool children to the baseline value, a response in the mean FEV 1 and in the mean FEV 0.5 of, respectively, 14% ± 10% and 15% ± 11%, suggesting that the latter would be useful in the assessment of bronchodilator response. (9) The good inter-rater reliability in the analysis and classification of the maneuvers by group indicates the reliability of the tests.…”

“…(1)(2)(3)(4)(5)(6)(7)(8)(9) The publication of reference values and study reports, showing that 40-90% of preschool children can perform spirometry appropriately, has promoted its use in clinical practice. (1)(2)(3)(4)(5)(6)(7)(8) The acceptability criteria for spirometry in adults, standardized by the American Thoracic Society (ATS), (10) cannot be applied to children, especially because of the brevity of the expiratory maneuver, usually lasting less than 2-3 s. The major technical limitation is early termination of exhalation (ETE), characterized by the sudden interruption of exhalation.…”

“…(1)(2)(3)(4)(5)(6)(7)(8) The acceptability criteria for spirometry in adults, standardized by the American Thoracic Society (ATS), (10) cannot be applied to children, especially because of the brevity of the expiratory maneuver, usually lasting less than 2-3 s. The major technical limitation is early termination of exhalation (ETE), characterized by the sudden interruption of exhalation. To allow for ETE, the following criteria for acceptable curves have been proposed (5,8,9) : minimum flows ≤ 25% of the highest PEF; minimum flows ≤ 10% of the highest PEF; and minimum flows ≤ 0.3 L/s. Considering the high frequency of ETE in the spirometric tests of preschool children, the ATS has proposed that the acceptability criteria be relaxed, and that curves with minimum flows ≤ 10% of the highest PEF be accepted.…”

“…Because there is no consensus regarding the criterion for curve termination in this age group, (5,6,8,9) the acceptable tests were divided into three groups, based on the criterion for curve termination, in order to determine the validity of partial maneuvers-no child was classified as belonging to more than one group. For the analysis, we selected only the tests with at least Considering the nETE and ETE≤10 groups collectively and by age (% of those in the sample as a whole), we obtained at least two acceptable curves in 9 children in the 3-year-old group (7.4%); in 36 children in the 4-year-old group (29.5%); and in 65 children in the 5-year-old group (53.3%), demonstrating that acceptability increases with age.…”

Forced inspiratory flow volume curve in healthy young children

“…The software also included an incentive-a computerized ''spirometry game'' for motivating maximal expiratory maneuver. 14,16 But it does not the inspiratory maneuver is not incorporated in the computerized game. Inspiratory efforts were therefore thought with the aid of mechanical incentive inspiratory devised or inspiratory whistle.…”